Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Food Service Establishment Inspection 26 (2)
e I 1 Establishment: NtRzSE RfE Inspection Date: o S Time: Qkoinsp REinsp Address/City: OAku{ND ROAD Health Dept: _50-TIf Vj:1N05b_ class: l z a® Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS Listing is not inclusive of all possible debatable items C I N/0 I WA IDNIC I KEY: C[complies] N/O[not observed] NIA[not applicable] Q tipd Fb4t QF isr ,� 3 DNC[does not comply] 0[other] RTE[ready-to-eat] ,� �b �A' a 12° ftes iltel vtwlth'tnf bt�n reetrfcted 61 6estgnated A�#erna#e � 4 2 C N/0 NtA 4 62 Written documentation of training program A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted 1 Approved source,wholesome,n©naduttera#ed C NIO NIA 4' C Communicable disease of worker reported to local healt 11 h director A Approved shellfish,finfish,meat&poultry USDA approved ./ 13 HarXhiveshing foci# pt vlded, tidswasltedr dean C NO PIfA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) J A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms, D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 3 Potn#1tia11 ;hazandags food Wrests temperotiiife requirements 0 €lt1Ci4�satrae,.pyeParaofi,dipty serwcae ttaaspurtaticn 4 o©d IW' pratctkes C NO td6A 2 A Hot holding greater than or equal to 140°F. (whole beef/pork roasts 1300 F.) A ❑ NO eating ❑ No smoking while working B Cold holding less than or equal to 450F. J B Wounds covered adequately J C Proper cooling C Proper sink used for handwashing �! D Proper re-heating 0 r E Proper internal cooking consumer advisory posted x �ittj* � tpt �emttal) 0 A Approved sanitizeravailable/adequate concentration ofsanitizer h#es mafrtt;in pract ct ' C Q ,t A �2; B Food-contact surfaces and utensils used for potentially tperaturie therm©meters provided hazardous food sanitized at least every 4 hours C Adequate ❑dishwashersanitizer Elfinal rinse temp A Food��ermometer available and accurate B Proper food thermometer for product D Proper sanitizin rocedure C Thermometers appropriately placed in cooler units E Sanitizing between raw animal origin&ready-to-eat food 0 0 _.Yes C Wd N/A- 1 d#splay,service and trerrspcsrte#lttn A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses �J 0 B Raw meats not stored/prepared near ready-to-eat foods 11 C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard J B Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 J 8 Food containers stored off the floor 1 o hYy ^ F . 9 Handiing of food,i riitrtlzed ` G N(6 PItA 2 a , .A.,.., A No unnecessary handling RTE and/or cooked foods with bare hands A Soa paper towels/ ing device available B Dispense ring: Soap Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C C Adequate utensil(s)for dispensing food/ice Handwash sink(s)clean/waste receptacle at handwash sink 0 r/ 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated altemate],PHF[potentially hazardous food],FB[foodborne] PHFs arglhWbeld at: OF. PHFs are cold held at: °F. Describe illness conditions when you would exclude a food worker from working: Are internal cooking ratures taken? Y N *To what temperature do you cook: Poultry round Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that re or er to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases tot *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y here-language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Na Is cooling monitored a&temp? Y N Is the monitoring of cooling recorded? Y N Indicate the title of above person(circle all that apply):QFO D Cook Owner FW *Obtain signature of the person who received the QFO responsibilities informatibtrat the time of the Is t produce washing policy? Y N ♦Describe what is washed and inspection: ere: Note: This report is a two page form(total of 62 debitab items Page 1 of 2 =.N C V g;rE 9 ENIMm Establishment: Date of Inspection: ,)SA`1 ddress: OAktgno 24g4 Owner or Operator: — ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,bacUlow -Stored properly,labeled properly,used properly Proper type/installation/backfiow prevention device/air gap for: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination Fdes etfacilities. Adequate,convenient,accessible, -Water quality in compliance gned,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] Sources of food: Original container,properly labeled 40 Garbage/rubbishstoragearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors:Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located Floor,wall juncture covered 12 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 81 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article 9 Walls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored !equipment&Utensils: Cleanliness 5 11 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 2 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 27 Nonfood-contact surfaces of utensils&equipment clean 54 Rooms adequate,clean,adequate lockers provided,facilities clean 55 Establishment and premises free of litter,no insect/rodent harborage, 28 Equipment/utensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesurovided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ,Routine Inspection OReinspection 0 Preoperational Inspection INSPECTOR: Other Inspection: ER N HAR Demerit Score: *Include demerits from page 1 4 3 2 1 Total Ratingsignatur si � print name print name phone number title DATE CORRECTIONS DUE: Ep,,` `���('� w N " Page 2 of 2 plus �continuation pages Focused Inspection 1/2002 ' Page Of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN I L DATE OF INSPECgTION St1c,se, C�. �, So��h WlnJser d I INSPECTION REMARKS EMARKSCM# Q z1, 00t C Dv Z.A ask, IObC wH� ' �'n��urki N o1E ®I5hWAS�czc Wi s (k) Rrrvs,�iF ok FN 079 ccgi� cn+zrthicAl s cw 6.�e,�+.. mow___. h aM 6er �s S�ace� `7 40145 reiCcG�'� C¢JfcK 1 2C C INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) X Distribution: 1st-White-Health Department 2nd-Yellow- Owner/Manager cAcerAinsformlert Establishment: Date of Inspection: ddress: Owner or Operator: ADDITIONAL FOUR POINT IT MS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. q 31 Sewage disposal approved -Unwrapped foods not re-served . 4' -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gapffor: -Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance - OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storage area/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints uter openings protected against entrance of insects/rodents loors: Floor covering installed,constructed as required,good repair,clean 16 pod-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required located 6 oor,walljuncture covered 1' onfood-contact surfaces designed,constructed,maintained, Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article AM Ils,ceilings attached,equipment properly constructed,good /01 20 Dishwashing facilities approved design,adequately constructed, pair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean ' 7 onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,stprage,handling no unnecessary articles 32 Proper disposal of wastewater 561 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 571 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection /Mber IN PER N IN AR E: Demerit Score: *Include demerits from page 1 e 4 3 2 1 Total Rating rslEafure It ature _ print name print n e " phone number title E; DATE CORRECTIONS DUE: Zoe �125 ��/lll...JJJ Page 2 of 2 plus continuation pages Focused Inspection 112002 Page of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION INSPECTION REMARKS FORM# e�, rx d-,ef-'k l —9 _ A J t i 7 � ev FKha _ DKW- 140 F Emp: Erop; PASS WHEN BLUE BAR TURNS ORANGE Date: • Fecha Empleado EmPleadP «ES ACE"ABLECUANDO LABARRAAZULCAMBIAACOLORNARMA 60°C Em PASS WHEN BLUE PASS WHEN BLUE P' Empleado BAR TURNS ORANGE BAR TURNS ORANGE - - ESAanAREC0AND0UBA4PA 'SA(EPA&EC1yAp RAgOpgp - - AMCWMACOIORNPAANIA ANLGAIRAACOIOAAN0.gY/p «180°Fi82-c «1601/710C —c�;l; INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) � S Distribution: 1 st-White-Health Department 2nd-Yellow- Owner/Manager i Establishment: Inspection Date: K& -- —0 Time: II ' REinsp Address/City: Health Dept: S .(�� l ld�O'L Class: 1 4 Based on an inspection this day,the items marked D C identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/O N/A NCI KEY: C[complies] N/0[not observed] NIA[not applicable] $ DNC[does not comply] 0[other] RTE[ready-to-eat] 2 A Food workers have no exposed infected lesions I burns U 2 IN_21912LB Personnel with infection restricted Qu � C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved = - " /A 41 B Food cans in good condition(not dented,rusty,bloated,leaking) tj A Handwash facilities in all food prep/dispensing&warewash areas C Wholesomelnonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities access lblelconvenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 0 .. _ ... iiii „ 2 Of A Hot holding greater than or equal to 1400F. (whole beeoporkroasts 130°F.) A ❑ No eating ❑�No smoking while working u B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 AP Approved sanitizeravailable/adequate concentration ofsanitizer B Food contact surfaces_and utensils used'' e for po entially hazardous food sand at least every 4 hou A Food thermometeravailableandaccurate C Adequate washersanitizer ' al rinse temp D B Properfoodthermometerforproduct Proper sanitizing procedure C Thermometers appropriately placed in cooler units Sanitizing between raw animal origin&ready-to-eat food 7 O Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor o 'its G+ A No unnecessary handling RTE andlorcooked foods with bare hands Soap I r towels drying device available B Dispen ing: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C I Handwash sinks)clean/waste receptacle at handwash sink C Adequate utensils)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated afiematel,PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the s th ere a produce washing policy? Y YN *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 Page l of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION S'a n Ta-�o (�,& 15 ,ce) INSPECTION v FORM# REMARKS �If - 1 ,24 -eu if =� INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) , Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager 4 Establishment: 1J Date of Inspection: ` - 'f��/ Address: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served -Operating as required -Potentially hazardous foods not re-served 11 Toxic chemicals. 34 No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backflow prevention device/air gap for:-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination-Water quality in compliance 35 Toilet facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents FA loors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, R Floors graded,drained as required located 6 Floor,walljuncturecovered 17 Nonfood-contact surfaces designed,constructed, maintained, 71 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean No reuse of single service article 9 Ils,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored EEquipment&Utensils• Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,noinsect/rodentharborage, 8 Equipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprovlded,good repair,clean entrance(s),smoking area indicated bysign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent pro ,clean outine Inspection ❑Reinspection ❑ Preoperational Inspection Other inspection: C R: PER I CHARGE: m rit Score: *Include demerits from page 1 4 3 2 1 Total Rating _ AlpPprint r �/ si ture erLT (Oa� G/ am print n e f`tk �/U� DATE CORRECTIONS DUE: phone Amber title Page 2 of 2 plus continuation pages Focused Inspee..n La i Establishment: Inspection Date: — — Time: CICNQ REinsp Address/City: Health Dept: , Class: 1 2 Based on an inspection this day,the items marked DNC identify the violations in operation orfacilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS: Listing is not inclusive of all possible debitable items C N/A DNC I KEY: C[complies] NIO[not observed] NIA[not applicable] m r 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 12' m_P soitnei Witfil ijnfdc64iii rdilrliiW 61 Cegnated Aetiate 2 C X 0 NfA 4 62 Written documentation of training program 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted 1 Approved source,wholesome,nonaduiterated C 1P N/A 4 C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 1.3 thand"ShIrligfacillitles provided,hands was ,clean 'C W0 WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadu Iterated foods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times mo_� t R � 'ttaotiijrage �practice G LtlO Nf,4 A Hot holding greater than or equal to 1400F. (Whole beef/pork roasts 1300 F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0__ E Proper internal cooking/consumer advisory posted 0 A Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially ,hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units — 0-MR i 1j� t n A Cloths and/or sponges to good repair and clean n ..[ B Wiping cloths kept in sanitizer between uses A Produce washed 0 B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor �F D09 , ed, . � t 'a ` r � ;' �i�t�ri a � �_� � � .� <,a�C�. � - 2� . � . . 4 9 . , A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbomej PHFs are hot held at: F. PHFs are cold held at: OF. Describe illness conditions when you would exclud r er from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to F are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there n illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N a eases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y Is there a language barrier between inspector&QFO? Y N If Yes indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the= g of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N ribe what is washed and inspection: where: //Note: This report is a two page form(t al of 62 debitable items) Page 1 of 2 11� '3 NAME OF ESTABLISHMENT DAT OF INSPECTION u,, . • . 1 XIV rtf-,,,ffl/ . / AM � � Cu � ,r _ _ W-IMPA is gr W54 �j 'Fo ml , WAS INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) ing Him , ILL _2 Establishment: Date of Inspection. ?Tj Address: Owner or Operator: ADDITIONAL POUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] ' 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved.-Operating as required -Potentially hazardous foods not re-served 34 No cross connections,back siphonage,backflow 11 Toxic chemicals. �pe�oe/installation/backflow,prevention device/air gap for: -Stored properly,labeled properly;used properly-Sanitizer concentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks-Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machinesProper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance designed,properly installed -Monitoring in compliance OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outer openings protected against entrance of insects/rodents 4 Floors: Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed, maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article alls,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed,located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required Q Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean 27 Nonfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodent harborage, 8 Equipment/utensils,storoge,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 571 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Proper toilet fixtures provided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent Koof,clean VRoutine Inspection ❑Reinspection ❑ Preoperational Inspection IN PERSON IN CH t spection: emerit Score: *Include demerits from page 1 4 3 2 1 Total Rating si ur &Jnature prirj na i e � �� pn�me Z L C[J, Ci✓V2� W DATE CORRECTIONS UE: -;i phone n tuber title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 1 R Establishment: Inspection Date: 2 Time: ROins RE]nsp ddress/City: Health Dept: .C.>iAI® ,ttl Class: 1 2 3 Based on an inspection this day,the items marked DN identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISOApproved Listing,is not inclusive of all possible debitable items C N/O WA NCIDmay: C[complies] NIO[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] 2 '. . .� WE,A Food workers have no exposed infected lesions/burns 2 B Personnel with infection restricted C Communicable disease of worker reported to local health director A h,finfish,meat&poultry USDA approved VV B Food cans in good condition(not dented,rusty,bloated,leaking) ° A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 4 E Handwashing at appropriate times 0 A Hot holding greater than or equal to 140 F. (Whole beef/pork roasts 13&F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking/consumer advisory posted 0 Approved sanitizer available/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometer available and accurate 00, C Adequate ❑dishwashersanitizer ❑final rinse temp B D Proper food thermometer for product Propersanitizin procedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 A Cloths and/or sponges in good repair and clean A Produce washed B Wiping cloths kept in sanitizer between uses B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor 0 A No unnecessary handling RTE and/or cooked foods with bare hands A Soap/paper towels I drying device available B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands V C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice 0 0 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. _M: QFO[qualified food operator],DA[designated aftemate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N Dyes indicate language spoken List products cooled: by CFO/DA: *Can the QFOIDA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N ♦Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 l D 41077_ 17!!� , 7 Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION Inspection Form M Remmics: A.1 jj < AJ 77) r INITIAL(INSPECTOR) IZV INITIAL(PERSON IN CHARGE) Distribution: I st-White-Health Department 2nd-Yellow-Owner/Manager c:kentinsform2.cn r Establishment: Date of Inspection: 7'6 "0 Address: Owner or Operator: ADDITIONAL FOUR POINT ITEMS . �� KEY: DNC [DOES NOT COMPLY] �. 6 Foods not re-served. -Unwrapped foods not re-served 4 31 Sewage disposal approved. 4 -Potentially hazardous foods not re-served -Operating as required 11 Toxic chemicals. No cross connections,back siphonage,backflow -Stored properly,labeled properly,used properly Proper type/installation/backfow prevention device/air gap for: -Sanitizerconcentration not to exceed maximum permitted -Food equipment -Hose connections -Dish machines -No unnecessary toxics on the premises -Soda system carbonator -Beverage dispensers -Toilet tanks -Pesticides/rodenticides properly dispensed -Chemical dispensers -Ice machines Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 Toilet facilities. Adequate,convenient,accessible, -Water quality in compliance-Monitoring in compliance designed,properly installed OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 Sources of food: Original container,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,clean 5 Potentially hazardous food properly thawed 41 Garbage/rubbish disposed of in an approved manner,at approved frequency 10 Food dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 43 Outeropenings protected against entrance of insects/rodents 4 Floors:Floor covering installed,constructed as required,good repair,clean 16 Food-contact surfaces designed,constructed,maintained,installed, 45 Floors graded,drained as required located 6 Floor,wall juncture covered 17 Nonfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article MV 219 ails,ceilings attached,equipment properly constructed,good 20 Dishwashing facilities approved design,adequately constructed, repair,clean.Wall&ceiling surfaces as required maintained installed located 50 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors 22 Wash water clean,proper temperature 53 Rooms&equipment hoods,ducts,vented as required 23 Accurate thermometers provided,dish basket,if used 54 Rooms adequate,clean,adequate lockers provided,facilities clean onfood-contact surfaces of utensils&equipment clean 55 Establishment and premises free of litter,no insect/rodentharborage, Equipment/utensils,stprage,handling no unnecessary articles 32 Proper disposal of wastewater 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 36 Toilet rooms enclosed with self-closing door 58 No live birds,turtles,or other animals(except guide dogs) 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ❑Routine Inspection ❑Reinspection ❑ Preoperational Inspection IN PE N I R : Other Inspection: Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating s' tur �r.•�e ag rin name prioname Y2,, DATE CORRECTIONS DUE: phone number title Page 2 of 2 plus continuation pages Focused Inspection 1/2002 Establishment: Inspection Date: 7—/ ,p Time: ROinsp72.. Address/City: iQ Health Dept:_e , r",/��6IL' Class: 1 Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on pag RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C WA DNC KY: C[complies] N/O[not observed] NIA[not applicable] $ 1 DNC[does not comply] 0[other] RTE[ready-to-eat] .. a 2 nel rfem ttct -.. Nf4n' 4'i 62 rtEten tiacumetttatai►t�etf tra�nlftg pr©gram 2 A Food workers have no exposed infected lesions/burns B Personnel with infection restricted L P.tt}Vei�Si41w'G8S9m6 "onad tte atEd Nf0. IA, C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved 14. E gz R C WA 4 B Food cans in good condition(not dented,rusty,bloated,leaking) c xrashin faeigties rssrn00 f�atx#swa hed,ct A Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe V B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) V C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature 1 D Personnel hands washed,clean/Proper handwash procedure 0 E Handwashing at appropriate times 100000, 0 - A Hot holding greaterthan orequal to 1400F. (whole beef/pork roasts fso'F.) A ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately 1000. C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 E Proper internal cooking I consumer advisory posted W 0 A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially I = hazardous food sanitized at least every 4 hours A Food thermometer available and accurate C Adequate ❑dishwashersanitizer ❑final rinse temp B Proper food thermometer for product L Proper sanitizin rocedure E Sanitizing between raw animal origin&ready-to-eat food C Thermometers appropriately placed in cooler units 0 0 A Cloths and/or sponges in good repair and clean B Wiping cloths kept in sanitizer between uses A Produce washed B Raw meats not stored/prepared near ready-to-eat foods C Food covered properly Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard g Single use gloves changed when soiled E No unauthorized personnel C Food--contact surfaces clean F No pooling of eggs not cooked immediately 0 8 Food containers stored off the floor ry` o ke A No unnecessary handling RTE and/orcooked foods with bare hand A Soap/paper towels/ drying device availables B Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice loo, 0 0 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate],PHF[potentially hazardous food],FB[foodbome] PHFs are hot held at: IF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N U—M indicate language spoken List products cooled: by QFO/DA: *Can the QFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions:Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the QFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 .10*N Sf4 7-0� O-P slot� ?d&U&Ot 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 SOR-CO TELEPHONE (860) 644-2511 June 20, 2008 Certified/Return Receipt 7008 0150 0002 6256 2518 Juliene Ayotte Sunrise Cafe 269 Oakland Road South Windsor, CT 06074 Re: Operation of Food Service Establishment, Sunrise Cafe,located at 269 Oakland Road, South Windsor, CT. Dear Ms.Ayotte: As you know, since March of this year,this office has been working with you in an effort to bring your food service establishment, Sunrise Cafe into compliance with Section 19-13-B42 of the Connecticut Public Health Code. Although you have made attempts to become compliant,there are many items that continue to be in violation. The following is a list of the repeat violations in order of precedence: 1. No hand wash sink in the rear preparation area. 2. Hand wash sinks continue to be used for discarding of food/beverage waste. 3. Personal belongings are stored throughout the food preparation area,primarily in the back preparation area. 4. Numerous food containers stored on the floor. 5. No sanitizing practices. 6. Sanitizing concentrations below required amounts. 7. Wiping cloths not stored in sanitizer. 8. No designated alternate. 9. No training documents. 10. Several dozen eggs, left out next to grill not refrigerated. 11. Numerous unnecessary articles throughout the establishment to include the cluttered office desk and files. This area is so cluttered that it prevents proper cleaning and sanitizing. 12. Dirty food containers under counter in back preparation area. 13. Ants. 14. Additional storage dry/equipment. The entire food preparation area(front and back)is in need of organization and repair. There are two large display cases that if were functional could assist in holding of foods. If the desk/office area in the back were removed or reduced and organized than the much needed dry storage areas could increase. This lack of organization,misuse of space and the limited space available are contributing to the violations. These recommendations are not the final solution to the violations but they suggest the need for planning. It is recommended that a food service consultant be employed to facilitate the process you will need for planning and designing a floor plan lay out that can support your current menu. The office has discussed these items and their importance as they relate to proper food handling and has seen little to no change. Unfortunately,this leaves no other alternative than to require the violations be resolved no later than July 15,2008. Failure to comply will result in orders issued by the Director of Health to cease food service operations. If you have any questions, I can be reached at 860-644-2511, extension 248. Very truly our , Robert De Vito,R.S. Environmental Health officer y ` r �0W N SfTio�u� ap slou� e 1540 SULLIVAN AVENUE •.SOUTH WINDSOR, CT 06074 r�OSox•co TELEPHONE (860) 644-2511 March 21,2008 Owner Sunrise Cafe 269 Oakland Road South Windsor,CT 06074 Re: Food Service Establishment Sunrise Cafe located at 269 Oakland Road in South Windsor, Connecticut Dear Owner: On March 21, 2008, a food service inspection was conducted at Sunrise Cafe located at 269 Oakland Road, South Windsor,Connecticut. At the time of the inspection,the rating score was 64 with three 4-demerit point item in violation. According to the Connecticut Public Health Code, a food service establishment must maintain a rating score of 80 or higher with NO 4-demerit point items in violation. Corrections of the violations noted must be made within two(2)weeks. If you have any questions or require additional information about the inspection, please contact me at (860)644-2511. Sincerely, Kevin Mattia M.S. Public Health Sanitarian Page_of INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENTj I TOWN DATE OF INSPECTION �• GC)., impsaim Form N Rwwb: �I 1141 2f I& _ s- J,� lu JJ4 A -k INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distributi : Ist-White-Health Department 2nd-Yellow-Owner/Manager c1catimformlat Page_of � y (4- zstt K 2y � INSPECTION REPORT STATE OF CONNECTICUT FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN Z Co9 A4e-i DATE OF INSPECTION SJiVYLLS5— CA F,r Wpec iw Form N Rewwb: � ��u� N-�c\�� S t e�,+� -To �Nt`� �i� ui� fob, �-1,A-+•s� �s�,,..r� �� tTvv 7 A tvTj !TLT' 'S ib jig V- - T- o Ff= F:�— S-a 9 1-6,T-�, -,-o C- I KI-)i vLS 5- 7\� 3-9- L-'-� o t�'Vt— 70 51 4F C" �`,� A t_,t. t�-S twT �� �2S'�-✓.� '70 �,� e.St�� cre.��-*��zSz'� A,-) c�•n� �w Aiz-�'� �o GSA n� o Ic7 Zcz U-1�\►St� -M iz S1bZ H,�a,.s0r`� vv� So Lv2 c� i 3 Cal _ 'b -,s-, °"c-te- ►4t-r-w,� A aCA ---------------------------- 3<j/ `►����� ;v �-l�,r� vlr,.�11 L..�,-1 B+J v 2 .i�►.S o t�'�J fl S�-L c� w,�-J,,.; lZt .s us ',v S,N SA"-e y S 7WC-r sT�l,as 2 S3-AX- y- oF- SLIccvf- -rb :R� e t,�-N ib 53;r �ro+U,sty 'Iv 7M 'b,, -os �tsK MACH, ��rnr� l-71,4 F INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1st-White-Health Department 2nd-Yellow-Owner/Manager 11 c:leenandormIcn Establishment: wt-ja-Ass CA�Flr_ Inspection Date: 3 zt D'k, Time: V,-t4'_ oins REins Address/City: ?-(o9 OAV_`ANY. S (Z.}b Health Dept: -►* Class: 1 2 3 4" Based on an inspection this day,the items marked DNC identify the violations in operation or facilities which must be corrected by the date specified on page 2. RISK FACTOR ITEMS:Listing is not inclusive of all possible debitable items C N/ N/A DIN C KEY: C[complies] N/O[not observed] NIA[not applicable] 3 DNC[does not comply] 0[other] RTE[ready-to-eat] pw., A Food workers have no exposed infected lesions I burns "' d{SCtIRntatiFil011J(kfIIFtI! B Personnel with infection restricted Ap{t OY 1 SQE#i ei xtih►iep nts,:nonad #et ted fNA C Communicable disease of worker reported to local health director A Approved shellfish,finfish,meat&poultry USDA approved B Food cans in good condition(not dented,rusty,bloated,leaking) * 01 �•C N10 Handwash facilities in all food prep/dispensing&warewash areas C Wholesome/nonadulteratedfoods/safe B Handwash facilities in or immediately adjacent to toilet rooms D Commercial products(no home grown/canned food) C Handwash facilities accessible/convenient to use E Potentially hazardous foods received at proper temperature D Personnel hands washed,clean/Proper handwash procedure 0 andwashing at appropriate times ;1r P .7 . A Hot holding greaterthan orequal to 1400F. (whole beef/pork roasts isooe) A 1 ❑ No eating ❑ No smoking while working B Cold holding less than or equal to 450 F. B Wounds covered adequately C Proper cooling C Proper sink used for handwashing D Proper re-heating 0 S t -^C, or A%Z—' E Proper internal cooking I consumer advisory posted 0 A Approved sanitizeravailable/adequate concentration of sanitizer B Food-contact surfaces and utensils used for potentially hazardous food sanitized at least every 4 hours A Food thermometeravailableandaccurate C Adequate ❑dishwashersanitizer inal rinse temp B Properfood thermometerfor product D Proper sanitizin rocedure Thermometers appropriately placed in cooler units 01 E Sanitizing between raw animal origin&ready-to-eat food C 0 o a A Cloths and/or sponges in good repair and clean F"� =' B Wiping cloths kept in sanitizer between uses VO A Produce washed B Raw meats not stored/prepared near ready-to-eat foods V 0 C Food covered Properly 'Z t N A Food equipment clean,utensils clean,equipment interiors clean D Adequate splash guards/sneeze guard B Single use gloves changed when soiled E No unauthorized personnel C Food—contact surfaces clean F No pooling of eggs not cooked immediately 0 8 od containers stored off the floor 0 IF — I A No unnecessary handling RTE and/or cooked foods with bare hands B Soap paper towels I drying device available Dispenser(s)working: ❑Soap ❑Paper towel B Minimize food handling,other than ready-to-eat,with bare hands woo C Handwash sink(s)clean/waste receptacle at handwash sink C Adequate utensil(s)for dispensing food/ice WI0 0 1 •DESCRIBE DEFICIENCIES ON CONTINUATION SHEETS The following information is not debitable and does not affect your score. KEY: QFO[qualified food operator],DA[designated alternate),PHF]potentially hazardous food],FIB[foodbome] PHFs are hot held at: OF. PHFs are cold held at: OF. Describe illness conditions when you would exclude a food worker from working: Are internal cooking temperatures taken? Y N *To what temperature do you cook: Poultry Ground Beef Pork What diseases related to FB illness are you required to report to the local health department? Roasts Other Describe re-heating procedures: Is there a written illness policy that requires the food worker to report specific illness conditions Are temperatures recorded/logged for cold holding foods/equipment? Y N and diseases to the QFO? Y N *Do you have a paid sick leave policy? Y N Are foods cooked in advance and cooled? Y N *Are leftovers saved? Y N Is there a language barrier between inspector&QFO? Y N If yes indicate language spoken List products cooled: by QFO/DA: *Can the CFO/DA read the inspection report? Y N Describe cooling methods: Indicate who answered the above questions: Name(print): Indicate the title of above person(circle all that apply):QFO DA Mgr Cook Owner FW Is cooling monitored for time&temp? Y N Is the monitoring of cooling recorded? Y N .Obtain signature of the person who received the CFO responsibilities information at the time of the Is there a produce washing policy? Y N *Describe what is washed and inspection: where: Note: This report is a two page form(total of 62 debitable items) Page 1 of 2 « o � " X, zt .. Establishment: �� �sL �%p��� Date of Inspection: t o Address: Owner or Operator: ADDITIONAL FOUR POINT ITEMS KEY: DNC [DOES NOT COMPLY] 6 Foods not re-served. 4 31 Sewage disposal approved. -Unwrapped foods not re-served 4 otentially hazardous foods not re served -Operating as required 11 To c chemicals. No cross connections,back siphonage,backflow Proper type/installation/backflow prevention device/air gap for: -Stored properly,labeled properly,used properly -Food equipment -Hose connections -Dish machines -Sanitizer concentration not to exceed maximum permitted -Soda system carbonator -Beverage dispensers -Toilet tanks -No unnecessary toxics on the premises -Chemical dispensers -Ice machines -Pesticides/rodenticides properly dispensed Proper drain for: 29 Water source adequate,safe. -Food equipment -Dish machines -Ice machines -Well/well head protected from contamination 35 -Water quality in compliance let facilities. Adequate,convenient,accessible, -Monitoring in compliance designed,properly installed' OTHER ITEMS KEY: DNC [DOES NOT COMPLY] 2 sJurces of food: Original contain ,properly labeled 40 Garbage/rubbish storagearea/rooms,enclosures-properly constructed,dean 5 Potentially hazardous food properly t awe 1 Garbage/rubbish disposed of in an approved manner,at approved frequency fo Fpdd dispensing utensils properly stored 42 Vermin Control: No insects/rodents present 14 Food worker:Clean outer clothes,effective hair restraints 3 Outer openings protected against entrance of insects/rodents 44 FI ors: Floor covering installed,constructed as req ' ,good repair,clea 16 Food-contact surfaces designed,constructed,maintained,installed, Floors graded,drained as required located 6 Floor,wall juncture covered 17 nfood-contact surfaces designed,constructed,maintained, 7 Mats removable,good repair,clean installed,located 18 Single service articles,storage,dispensing 8 Exterior walking,driving surfaces,good repair,clean 19 No reuse of single service article Iff W lls,ceilings attached,equipment properly constructed,good epair,clean.Wall&ceiling surfaces as required 20 Dishwashing facilities approved design,adequately constructed, maintained installed located 501 Dustless cleaning methods used,cleaning equipment properly stored Equipment&Utensils: Cleanliness 51 Adequate lighting provided as required 21 Preflushed,scraped,soaked and racked 52 Room free of steam,smoke odors Wash water clean,proper temperature �S 53 Rooms&equipment hoods,ducts,vented as required 2 ccurate thermometers provided,dish basket,if used 54 R obms adequate,clean,adequate lockers provided,facilities clean 2 Nonfood contact surfaces of utensils&equipment clean 5 ablishmentand premises free of litter,no insect/rodentharborage, 28 iquipmentlutensils,storage,handling no unnecessary articles 32 Proper disposal of waste water 56 Complete separation from living/sleeping quarters and laundry 33 Plumbing location,installation,maintenance 57 Clean/soiled linens stored properly 58 No live birds,turtles,or other animals(except guide dogs) 36 Toilet rooms enclosed with self-closing door 59 Seats 75 or more:Nonsmoking area provided,sign(s)posted at 37 Propertoiletfixturesprpvided,good repair,clean entrance(s),smoking area indicated by sign(s) 39 Approved garbage/rubbish containers,adequate number,covered, rodent proof,clean ;(Routine Inspection ❑Reinspection ❑ Preoperational Inspection PE T R: PERSON INCHARGE: Other Inspection: Qg� Demerit Score: *Include demerits from page 1 4 3 2 1 Total Rating signature nature print name pri name I 1 1 [ywber title phone number 2S ( tyyJ�� DATE CORRECTIONS DUE: Ll 1-1 o Page 2 of 2 plus 1 continuation pages Focused Iuspectiou 1/2002